Dupilumab for Severe COPD Shows Efficacy, Tolerability, Patient Satisfaction in New Real-World Study

In a real-world case series presented at the 2025 American Thoracic Society (ATS) International Conference, dupilumab therapy was associated with fewer exacerbations and improved symptom scores in patients with severe chronic obstructive pulmonary disease (COPD) and evidence of type 2 (Th2) inflammation, according to first author Ophir Freund, MD, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, and colleagues.

Ophir Freund, MD

Courtesy of ResearchGate

The 14-patient cohort, treated at pulmonary centers in Israel, included individuals with elevated blood eosinophil counts (BEC) and exacerbation during the prior year despite a regimen of triple inhaler therapy—mirroring the population studied in recent pivotal trials.

All participants had blood eosinophil counts of 300 or more cells/μL and disease severity as classified by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) of 3E (43%) or 4E (21%). The group had a median treatment duration of 187 days and completed structured interviews assessing clinical outcomes and satisfaction.

Compared to the 6-month period prior to starting treatment with dupilumab, patients experienced a reduction in COPD exacerbations, with median annualized events decreasing from 2 (IQR: 2–2) to 1 (IQR: 0–1). Symptom burden also improved, as reflected by a reduction in COPD Assessment Test (CAT) scores (median 17 before treatment vs. 14 during treatment). Lung function, measured by FEV1, remained stable.

Patient-reported outcomes suggested broad satisfaction with therapy. More than two-thirds (69%) of patients were satisfied with dupilumab, and 62% said they would recommend it to others with COPD. According to the Global Evaluation of Treatment Effectiveness (GETE) tool, 38% of patients reported marked improvement.

Dupilumab was generally well tolerated, with only one patient reporting a mild skin-related side effect. Cost (cited by 50% of respondents) and the need for repeated injections (29%) were noted as key barriers to long-term use.

These findings provide early, real-world support for dupilumab’s role in a select COPD population characterized by type 2 inflammation, echoing results from the BOREAS and NOTUS trials. As clinicians consider incorporating biologics into COPD management, especially for patients with frequent exacerbations and elevated eosinophils, this data reinforces the need for further research and improved access pathways.

Dupilumab, which targets the interleukin-4 (IL-4) and interleukin-13 (IL-13) pathways, has been shown to reduce type 2 inflammation, a central driver in many chronic respiratory and allergic conditions. Marketed as Dupixent, dupilumab was approved in September 2024 by the FDA as add-on maintenance therapy for adults with inadequately controlled COPD and evidence of an eosinophilic phenotype. Dupilumab was the first biologic agent approved in the US to treat the chronic lung disease and the first new treatment approach for COPD in more than a decade.2

References

1. Freund O, Meoded O, Cohn-Schwartz D, et al. Real-world experience of duplimab treatment of patients with COPD. [abstract]. Am J Respir Crit Care Med 2025;211:A6177. doi:10.1164/ajrccm.2025.211
2. Halsey, G. Dupilumab becomes first biologic approved in the US as targeted therapy for adults with COPD. PatientCareOnline website. September 27, 2024. Accessed May 27, 2025. https://www.patientcareonline.com/view/dupilumab-becomes-first-biologic-approved-in-the-us-as-targeted-therapy-for-adults-with-copd